<?php
/**
 * Created by JetBrains PhpStorm.
 * User: Do
 * Date: 11/11/13
 * Time: 3:02 PM
 * To change this template use File | Settings | File Templates.
 */
?>
<link href="<?php echo base_url(); ?>public/admin/css/user.css" rel="stylesheet" type="text/css">
<div class="main-div">
    <div>
        <h2 class="user-title">Thông tin thành viên</h2>

    </div>
    <div class="account-info">
        <h3>Thông tin tài khoản</h3>
        <hr>
        <div class="account-info-content">
            <div class="form-field">
                <label for="email" class="cm-required label-static-info">Email:  <span class="red-text"">*</span></label>
                <div class="input-prepend">
                    <span class="add-on"><i class="icon-envelope"></i></span>
                    <input type="text" id="email" name="user_data[email]" size="32" maxlength="128" value="<?php  echo $load_email;  ?>" class="input-text" />
                </div>
            </div>
            <div class="form-field">
                <label for="password1" class="cm-required cm-password label-static-info">Mật khẩu: <span class="red-text"">*</span></label>
                <div class="input-prepend">
                    <span class="add-on"><i class="icon-lock"></i></span>
                    <input type="password" id="password1" name="user_data[password1]" size="32" maxlength="32" value="" class="input-text cm-autocomplete-off" />
                </div>
            </div>
            <div class="form-field">
                <label for="password2" class="cm-required cm-password label-static-info">Nhập lại mật khẩu: <span class="red-text"">*</span></label>
                <div class="input-prepend">
                    <span class="add-on"><i class="icon-lock"></i></span>
                    <input type="password" id="password2" name="user_data[password2]" size="32" maxlength="32" value="" class="input-text cm-autocomplete-off" />
                </div>
            </div>
            <div class="form-field">
                <label for="birthday" class="cm-required label-static-info">Năm sinh: <span class="red-text"">*</span></label>
                <div class="input-prepend">
                    <span class="add-on"><i class="icon-calendar cm-external-focus calendar-but valign" rev="birthday" title="Lịch" alt="Lịch"></i></span>
                    <input type="text" id="birthday" name="user_data[birthday]" class="input-text-medium cm-calendar" value=""  size="10" />
                </div>
            </div>
            <div class="form-field">
                <label for="elm_42" class="cm-required label-static-info">Giới tính: </label>
                <select class="select-combobox"id="elm_42">
                    <option value="">--</option>
                    <option  value="1">Nam</option>
                    <option  value="2">Nữ</option>
                </select>
            </div>
            <br />


        </div>

    </div>

    <div class="delivery-info">
        <h3>Thông tin khác</h3>
        <hr>
        <div class="delivery-info-content">
            <div class="form-field">
                <label class="cm-required cm-email label-static-info">Họ tên: <span class="red-text"">*</span></label>
                <div class="input-prepend">
                    <input type="text" name="user_data[name]" size="32" maxlength="128" value="<?php  echo $load_name;  ?>" class="input-text" />
                </div>
            </div>
            <div class="form-field">
                <label for="elm_42" class="cm-required label-static-info">Tỉnh/Thành Phố: </label>
                <select class="select-combobox" id="elm_42">
                    <option value="">--</option>
                    <option  value="1">Hồ Chí Minh</option>
                    <option  value="2">Bình Phước</option>
                </select>
            </div>
            <div class="form-field">
                <label for="elm_42" class="cm-required label-static-info">Quận/Huyện: </label>
                <select class="select-combobox" id="elm_42">
                    <option value="">--</option>
                    <option  value="1">Quận 1</option>
                    <option  value="2">Quận 2</option>
                </select>
            </div>

            <div class="form-field">
                <label for="elm_42" class="cm-required label-static-info">Phường/Xã: </label>
                <select class="select-combobox" id="elm_42">
                    <option value="">--</option>
                    <option  value="1">Bến Nghé</option>
                    <option  value="2">Bù Đăng</option>
                </select>
            </div>
            <div class="form-field">
                <label class="cm-required cm-email label-static-info">Số nhà/Ngõ/Ngách: </label>
                <div class="input-prepend">
                    <input type="text" name="user_data[home]" size="32" maxlength="128" value="" class="input-text" />
                </div>
            </div>
            <div class="form-field">
                <label class="cm-required cm-email label-static-info">Đường: </label>
                <div class="input-prepend">
                    <input type="text" name="user_data[street]" size="32" maxlength="128" value="" class="input-text" />
                </div>
            </div>
            <div class="form-field">
                <label class="cm-required cm-email label-static-info">Lầu: </label>
                <div class="input-prepend">
                    <input type="text" name="user_data[floor]" size="32" maxlength="128" value="" class="input-text" />
                </div>
            </div>
            <div class="form-field">
                <label class="cm-required cm-email label-static-info">Điện thoại:</label>
                <div class="input-prepend">
                    <input type="text" name="user_data[phone]" size="32" maxlength="128" value="<?php  echo $load_phone;  ?>" class="input-text" />
                </div>
            </div>
            <br />

            <input type="button" class="btn-register-user-info" value="<?php  echo $name_button;  ?>">
        </div>

    </div>

</div>